California Licensed Medical Management Specialist

Job Summary

Working remotely on a full-time basis, the California Licensed Medical Management Specialist will promote quality and cost-effective care for SCAN members by managing utilization processes, conducting reviews, and coordinating complex medical cases according to regulatory guidelines.

Key responsibilities

• Manage requests for services and ensure adherence to medical necessity and cost-effectiveness guidelines
• Conduct pre-service and concurrent reviews in collaboration with the Medical Director, applying established clinical criteria
• Coordinate care for members requiring urgent services and facilitate safe discharges from inpatient settings

Required qualifications

• Graduation from an accredited school of Licensed Vocational Nursing or equivalent clinical experience
• Current and active California Licensed Vocational Nurse
• 3+ years of experience in medical-surgical nursing and Utilization Management/Prior Authorization
• Knowledge of California managed care industry and federal/state healthcare regulations
• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint